1. Field of the Invention
The present invention relates to a computer based system for rapid triage of patients in a hospital emergency department setting so that each patient is consistently and comprehensively evaluated upon entering the emergency department, regardless of the level of training of the personnel involved in the initial evaluation of the patient and regardless of the patient""s problem. In thus providing a standardized method for evaluating and prioritizing patients based on the criticality of their conditions, the system provides more reliable and better prioritization of patient care in the emergency department setting. This system is designed to prevent hospital personnel from not recognizing the criticality of certain life threatening conditions and the resulting postponement of treatment based on an initial error in identifying the severity of the patient""s problem. The system has special triage routines for children who face the greatest danger in triage evaluation due to their limited ability to communicate and due to the differences in their physiology as compared to adult patients.
The triage system includes a computer interface so that the emergency department physician has constant real time information on the criticality of each patient in the emergency department, thereby enabling the medical personnel to provide priority attention to those patients that have the most critical conditions. The computer interface of the triage system also provides the treating physician with a print out of the patient""s information at the time the physician first sees the patient. That print out is a permanent record of the triage process for that patient.
2. Description of the Related Art
The normal procedure when a patient enters an emergency department is that either a nurse or a medical technician asks the patient a few questions about the patient""s condition. They may or may not routinely take vital signs. Based on this initial evaluation of the patient""s symptoms, and possibly vital signs, the medical professional then makes a decision about the criticality of the patient""s condition and assigns a criticality or triage rating to each patient. Patients in the emergency department are then prioritized for receiving medical attention based on the medical professional""s assigned critically of the patient""s condition. This process is called triage which means xe2x80x9cto sortxe2x80x9d, and the criticality rating is the triage level.
Currently, the decision regarding the criticality of the patient""s condition can never be better than the experience and training level of the attending medical professional. If the attending medical professional is not well trained, is inexperienced, or for some other reason fails to ask the right questions, or if the patient is suffering from a condition that is rarely seen in the emergency department or a condition that exhibits symptoms that appear less severe than the actual critical nature of the patient""s problem, the medical professional can easily make an error in assigning criticality to the patient""s condition.
Emergency department triage is particularly difficult, even for well trained and experienced medical professionals when they operate without clear guidelines and without a well established decision tree that can be employed to make sure they ask the right questions every time and then properly evaluate the patient""s condition based on the answers to their questions and based on their observations of the patient""s physical condition. Even if the medical professional does a comprehensive nurse assessment, including obtaining the chief complaint, past medical and surgical history, medications and allergies, and spends a great deal of time acquiring this information, the medical professional may still wonder whether they made the right triage decision about a patient.
If the medical profession has triage guidelines that consist of a laundry list of clinical conditions parceled into triage levels, these lists are usually too long and difficult to remember so that they are rendered impractical to use on a patient-by-patient basis.
Errors in triage decisions can result in a patient who has a serious or even a life threatening condition that is badly in need of immediate medical care being allowed to remain in the emergency department waiting area without being treated while other less critical patients are given medical attention.
Obviously, these types of errors in triage of emergency department patients are undesirable from the patient""s standpoint who may need immediate care and who can not get it because emergency department personnel did not properly identify the critical nature of his condition. These types of errors are also undesirable from the hospital""s and physician""s standpoints because both are morally dedicated to helping people and both are financially at risk for failing to provide the proper level of care to patients.
The present invention addresses these problems by providing a computer based triage system that helps eliminate most of the burden of triage decision making from the medical professional while still allowing the medical professionals to apply their observational skills and experience.
The present system is a stand alone, chief complaint based, algorithm driven triage system. First, this means it does not require integration with existing hospital computer systems, thereby eliminating the barriers to its use caused by problems and costs associated with integrating it with existing hospital computer systems. The present system is a stand alone, Web-based application that is easy to use, easy to access, and easy to maintain.
Second, the system is based on the patient""s presenting chief complaint. Rarely does a patient come into an emergency department with a diagnosis in hand, but rather they present with a symptom or group of symptoms to the emergency department medical professional. The challenge for the medical professional is in differentiating between those who are not sick from those who are acutely ill, or even worse, those with potentially life-threatening conditions masquerading as a common, minor symptom.
Finally, the present system is driven by standardized algorithms. These algorithms are the heart of the system. For any given chief complaint given by a patient, there are a series of observations and questions that, based upon the observations made by the medical professional or answers given to the questions either by the patient or a person who comes to the emergency department with the patient, will lead down a specific decision tree or clinical pathway. These decision trees or clinical pathways are referred to as algorithms. The beauty of the system is that the intuitive clinical judgment used to spot potentially life threatening clinical conditions is built into the logic of the system. The system, by nature of the questions asked or information required, takes into consideration the patient""s chief complaint, and their sex, age, vital signs, and pertinent past and present medical history in order to make a triage determination.
Even though this system is standardized and computerized, it is not infallible. Therefore, if medical professionals believe that a patient""s condition is more critical than the triage level assigned by the system, the system can always be overridden to require a higher triage level for a patient, i.e. a triage level that would indicate that the patient is more critical than the triage level that was assigned to the patient by the system. However, as a conservative measure, the system can not be overridden to assign a lower triage level for a patient, i.e. a triage level that would indicate the patient is not as critical as the triage level that was assigned to the patient by the system.
The present system provides a clinical pathway for making observations and asking questions to allow a medical professional to quickly and accurately arrive at a final triage determination. The triage level is not established by diagnosis since there is no certain diagnosis at the time of triage but is based only upon the potential for certain clinical conditions based on the presenting clinical status of the patient and the patient""s symptom complex. The system is designed to look at a patient as a whole, including the patent""s physical appearance, age, sex, vital signs, pertinent past and present medical history, and presenting complaint, in making a triage determination.
The system employs a five tier triage scale consisting of levels I, II, III, IV, and V that are referred to respectively as immediate, emergent, urgent, semiurgent, and non-urgent. Level I conditions are life threatening and require immediate medical attention and intervention. Level II conditions are potentially life threatening and require emergent medical attention. Level III conditions may develop into a serious problem unless urgent medical evaluation and intervention is received. Level IV conditions are semi-urgent and may benefit from intervention to prevent deterioration or complications. Finally, Level V conditions are non-urgent conditions that are minor and could be delayed or deferred to other areas of the health care system with little risk of significant deterioration.
This system does not propose to dictate clinical standards for the specific time periods a patient needs to be evaluated and treated for any given triage level. Decisions regarding the time to be seen are entirely the decision of the local medical community and existing or future national guidelines. Also, this system does not propose in which area of an emergency department that patients should be seen or by whom. Where a patient with a particular triage level needs to be taken care of and who should supply that care is a decision that is best left to the individual hospital.
The present invention is a computer based system for rapid triage of patients in a hospital emergency department setting so that each patient is consistently and comprehensively evaluated upon entering the emergency department, regardless of the level of training of the personnel involved in the initial evaluation of the patient and regardless of the patient""s problem. The system is to be employed by emergency department medical professionals to provide a standardized method for evaluating and prioritizing patients based on the criticality of their conditions, thus providing a more reliable and better prioritization of patient care in the emergency department setting.
This system includes overlapping pathways for evaluating and assigning a triage level to a patient""s condition based on the medical professional""s observations about the patient""s condition, the patient""s age, the patient""s vital signs, and a series of scripted questions and observations in a selected algorithm that is selected based on the patient""s chief complaint. The system is designed to prevent hospital personnel from not recognizing the criticality of certain life threatening conditions and the resulting postponement of treatment based on an initial error in identifying the severity of the patient""s problem. The system also allows the medical profession flexibility in the order in which the steps of triage are done and entered into the system, including the ability to postpone completion of triage on one patient so that triage can be begun on one or more other patients.
The system has special triage routines for children who face the greatest danger of misevaluation in triage due to their limited ability to communicate and due to the differences in their physiology as compared to adult patients.
The triage system includes a computer interface so that the emergency department physician has constant real time information on the criticality of each patient in the emergency department, thereby enabling the medical personnel to provide priority attention to those patients that have the most critical conditions. The computer interface of the triage system also provides the treating physician with a print out of the patient""s information at the time the physician first sees the patient. That print out is a permanent record of the triage process for that patient.